The great Greek physician and teacher Hippocrates (460 BC-370 BC) described several kinds of cancer, referring to them with the Greek word "carcinos", meaning crab or crayfish. This name comes from the appearance of the cut surface of a solid malignant tumor, with the "veins stretched out on all sides as the animal the crab has its feet, whence it derives its name."

Category Archives: General Observations

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I miss letters. Rather, I miss sending AND receiving letters in the mail, real letters on stationery. Our cultural communication has been reduced to tweets, posts, texts, emails and Facebook messages. Another part of growing older is remembering and cherishing this simpler method of communication. I guess I am old.

I have always been a letter writer. I remember as a child writing to both of my grandmothers who lived in California. Both were widowed and led quiet lives, and at the time I just thought it normal to correspond regularly with them. Now I realize how much they must have enjoyed receiving my crudely crafted letters. The news to share was probably silly in hindsight; what grades I got on my spelling test (yes they actually tested for spelling back in the day) or what our pets were doing or how pretty was the dress my mother had recently sewn for me. The postal rates were regular mail and air mail, and of course air mail was preferred. There were “air mail” stickers to plaster across the envelopes and to keep postage down we wrote on flimsy air mail stationery so that long letters were lightweight and could pass under a single unit of postage. Of course we used fountain pens. Oh and don’t forget the sealing wax. For my 8th birthday I received a set of stamps and sealing wax candles. I can still smell the wax as it dripped onto the point of the envelope seal, and then I would select (quickly) the stamp of choice and stamp firmly, leaving a distinct initial or fleur de lis.

My father dutifully wrote each week to his mother, as did my mother to hers, but somehow I remember my father’s efforts more. Phoning long distance to California was a luxury – forget unlimited talk or cell phone freedom – and so perhaps I observed his habit and incorporated it into my own routine. When I left for college in 1970 my father wrote to me every week, and I loved opening my mail box in the Student Center and seeing his distinctive script scrawled across an envelope. The letters were short, scratched out on tablet paper that I recognized from his work, and he always enclosed a few dollars for a treat. Usually our correspondence revolved around how the Dallas Cowboys had fared recently, or how his golf game was or just stuff about the family. I saved every one of his letters and gathered them with ribbon. Thank heavens in all the purging my parents did during retirement they didn’t throw out my special box of college mementos. While cleaning out my mother’s house last spring I found all of MY letters that I had written to him. He had saved them all too.

Preparing my 90 year old mothers’ house for sale was a tough project. But there were treats along the way. Packed carefully away in an old trunk were three sets of letters, bound up in aged ribbon and yellowed with time. The first set were letters written to my grandmother from her then fiancée, the grandfather I never knew as he died when my mother was 12. The paper was filmy onion skin, the script exquisite in its fluid loops and dips. Why did we stop teaching penmanship in schools? His cursive was amazingly beautiful, from a different era – I was dropped back in time into 1918. I felt almost guilty reading about the anticipation about their upcoming nuptials. The letters were sweet and innocent and filled with fervent passion about their future together. The next set were the letters my grandfather had written to his daughter (my mother) while she was at camp – the summer she was 12. A smaller stack, but the poignant part of that keepsake was the final letter written just before he was scheduled for surgery from which he did not survive. The letter arrived after he passed away. My mother put that final letter on top and bundled them up. I am pretty sure she never revisited that correspondence. She confided years ago that her childhood ended that day; that she felt old and heavy at the young age of 12 as she was an only child and felt enormous responsibility to care for her mother, a 42 year old widow who had never worked a day in her life or finished high school. She was her mother’s caregiver until my grandmother passed away at age 98.

The final set were letters my father wrote to my mother during their courtship. I recognized my father’s scrawl immediately. It was more legible back then; hard to believe he had already served during World War II, gone to college on the GI bill and was just starting out at Shell Oil at the ripe old age of 30. He and my mother were engaged and he had been transferred out of town; so writing letters was the way they kept in touch. Again I felt like a voyeur, but it was a wonderful piece of our family history that was indescribably beautiful.

As I ponder the New Year, I think about the ways I would like to make my life more meaningful. I can lose a few pounds and exercise more, play more and worry less – but it occurred to me that I would like to write more and spend more time with pen to paper. My calligraphy lessons have infused me with a new passion for the beauty of the printed word, but I know also the simple act of writing a letter to someone will give them more pleasure than it gives me. So for my lovely mother-in-law and the elderly lady in California who we enjoy helping out – there is a fresh stack of note cards ready to be filled. All I need is the sealing wax. Amazon Prime is taking care of that.

If books are a uniquely portable magic, the same cannot be said for hundreds and hundreds if not thousands of books, but port them we did. The first thing that my husband and I noticed about the house we ended up buying was the library—a room completely lined from top to bottom with built in bookcases. I have lived in many places, and set up makeshift bookshelves from salvaged boards and cinder blocks, and later, the do it yourself–put them together to watch them fall apart IKEA models—but I have never had a library. Say it with an affected British accent if you will—the “lye-brahr-ry”, or feign embarrassment and call it the “TV room”, this library has become the focal point of our home.

I consider myself fortunate—my family has always revered books. I have two volumes from my mother’s childhood, Mary Poppins and Mary Poppins Comes Back, reprinted in August 1941. You don’t remember Mary Poppins? Let me jog your memory of a far more innocent time: “If you want to find Cherry-Tree Lane, all you have to do is ask the Policeman at the crossroads.” At the end of the second chapter, the children Jane and Michael ask Mary where she’s been on her day off. She replies, “In Fairyland.” They are baffled when she tells them that she did not see Cinderella or Robinson Crusoe. They proclaim that she could not have been in THEIR Fairyland. Mary Poppins gives a superior sniff and replies, “Don’t you know, that everybody’s got a Fairyland of their own?”

My own Fairyland was created by Walter Farley, and Marguerite Henry and Albert Payson Terhune. Farley wrote the famous Black Stallion and Island Stallion series of stories about Alec and The Black, an Arabian washed ashore with the young boy who tames him after a shipwreck, and Steve Duncan and Flame, the chestnut stallion he discovers on the mythical Caribbean island of Azul. Henry wrote Misty of Chincoteague, and Stormy, Misty’s Foal, inspiring little girls of my generation to long for their very own ponies. Terhune wrote Lad, a Dog which I read when I was ten. Twelve years later, while in medical school, the first puppy I ever bought on my own was a collie. The dreams and myths inspired by a childhood of reading never really go away.

And so, when my children were young, I bought books upon books, and since I worked during the day, we read them together late into the night, before Harry Potter, which they were old enough to read on their own, and before video games, and computers and Facebook. The kids had their favorites—one was The Ox-Cart Man, describing the rhythmic seasons of life in colonial New England, by Donald Hall who later became poet laureate of the United States. They also loved Wilfred Gordon McDonald Partridge, about a young boy who helps an elderly lady in a nursing home regain her memory by bringing her objects from the past, and of course The Giving Tree, by Shel Silverstein about selflessness and unconditional love.

When the kids grew up, and graduated to their own taste in reading material, I put away the children’s books—packed them lovingly into boxes and put them out in the shed by the barn. And there they sat, quiet and safe, until the movers from Allied Van Lines retrieved them and brought them here, to the library. As I unpacked all the boxes, the memories of childhood—my mother’s, my own, and my children’s came back full force as I indulged myself by opening and rereading nearly all of them, until I came to my own favorite, written and illustrated by Barbara Cooney in 1982, two years before my daughter was born. It’s called Miss Rumphius, about a little girl named Alice who grows up and travels far and wide, but comes home to a city by the sea, where she plants lupines and becomes known as The Lupine Lady. As a little old lady, she tells stories of her adventures to her great niece, also named Alice. Little Alice says, “When I grow up, I too will go to faraway places and come home to live by the sea.” The Lupine Lady says, “That is all very well little Alice, but there is a third thing you must do.” “What is that?” asks little Alice. Her great aunt replies, “You must do something to make the world more beautiful.” “All right” says little Alice, who then reflects, “But I do not know yet what that can be.”

If books can inspire our children to make the world a more beautiful place, then they are indeed magic. I am so glad I kept all of ours.

Some of us think of the automobile as a means of transportation and nothing more. Others, like me, see the car as something else entirely—an extension of ourselves, and an expression of identity. Growing up I was influenced by my dear old Dad—our childhood was marked by a succession of American made muscle cars from the 1966 Ford Thunderbird convertible which met its sad end on the 610 freeway in the rain, to the Pontiac Firebird Formula 400 I drove out to Big Bend National Park, reaching its top speed of 160mph on a lonely stretch of interstate 10 before my new husband cried “Uncle!” The first car I ever bought myself was a 1975 Chevy Camaro, V8 engine, bright red with white vinyl upholstery. I was 21, and I was GOING PLACES. I enjoyed that car for seven years until one too many spin-outs on Route 9 in the snow after I moved to Boston convinced me that it was time for something more practical. The day I drove my brand new front wheel drive bronze Nissan Stanza out of the lot was the day I knew I had made a big mistake. I was born for red cars with big engines. I like people to see me coming.

Sometimes, however, we have to be practical. By 1991 I had three children and a growing menagerie of pets. I got my first Chevy Suburban, known then and probably now as the “National Car of Texas” on a company lease, and from then on I was hooked. That car was indeed “like a rock.” I drove it until the lease was up and then got another, this time the heavy duty three quarter ton with enough power to tow my house. The menagerie had grown to include horses by then, and I wanted a car that I could both live in and drive with three kids, 2 horses and an assortment of dogs. There was nothing comparable to the trusty Suburban in the automotive world. A bemused trucker watched me struggle into a parking space at a truck stop and actually taught me how to park my behemoth. By 2001 I realized that the horses were safer with professional drivers and big rigs, and I “traded down” to my current Suburban, affectionately known as “Big Red.” That was in the spring of 2001, and I was in love—with a big red car.

I’ve had Big Red for nearly 14 years and 230,000 miles. Shortly after the model year 2001, Chevrolet in its infinite wisdom decided to turn the historic first true sport utility vehicle into a soccer mom-grocery shopping car. Gone was the bench middle seat, replaced by “captain’s chairs” for easier access to the third row. Gone were the “barn doors” which opened from the middle out, one at a time, replaced by the hydraulically lifted single back window-door, which may have provided better grocery access, but was entirely impractical for those of us carrying three to four hundred pounds of dog, all wanting to exit the vehicle at the same time. Gone was the middle seat that folded entirely flat, allowing the entry of two 700 size dog crates, the only passenger vehicle to this day which had that much cargo space. In my distress over the changes to my beloved Suburban, I spent an hour on the phone with a Chevy customer service representative from India, who duly noted my concerns, but had no idea what I was talking about.

Last week I covered a practice in El Centro, about 140 miles east of my home in Rancho Santa Fe. I felt Big Red shudder and heave going over the Laguna Mountains. For the first time ever, cars were passing me to the left as I struggled to maintain 55 mph. My good friends at Quality Chevrolet have been patching the air conditioning compressor together for years, but this was something entirely new. Fearing the worst, I took the car back to the dealer today, with clear “Do Not Resuscitate” orders. All day I waited, and finally around 4 pm I got a call from service. Bill said, “Ma’am, I think your engine and transmission are okay. We found a faulty oxygen sensor. We’ll replace it tomorrow. You’ll be good to go.”

Good to go to New Mexico? I sure hope so. I don’t want a new car. I love Big Red. I am loyal and I persevere. The Chevy Suburban no longer comes in red. My family thinks I’m nuts.

“But I reckon I better light out for the Territory ahead of the rest, because Aunt Sally she’s going to adopt me and sivilize me and I can’t stand it. I been there before.”

Mark Twain, Huckleberry Finn

While I wasn’t looking, someone snuck up behind me and bought my house. Well, not exactly “bought” yet, but all contingencies are removed and the closing date is set for October 3. This wasn’t supposed to happen. My realtor told me that our place is “special”, a euphemism for “old run down house with wonderful horse facilities.” She said it might take a year to sell, and that the right buyer would come along—someone who wasn’t too house proud, but who wanted to “live the dream,” as I did seventeen years ago. Someone who had always wanted a horse of her own and had waited a very long time to get one—or two or three or maybe even four. Someone, in short, just like me. And let’s face it folks—how many people are out there who are just like me? Apparently quite a few. The house sold in ten weeks for close to the asking price. And there are back up buyers, who just didn’t get back to see it for a second showing in time.

For seventeen years, I put off having friends and family visit. I had no dinner parties because we were embarrassed. The house was a mess. The carpet was old, and pet worn and smelly, the roof leaked, the kitchen was hideous, the “powder room” was a disgrace with orange and brown tiles left over from the 1970’s. But my children, my dogs and my horses were blissfully happy with the place. It was home. When my friend Catherine passed away in late 2012, she left me a little bit of money, which I used wisely for a new paint job, new carpet and curtains, a stunning garage renovation (after all, it belongs to my dogs!), a bathroom facelift and some nice hardware for the newly painted cabinets in the kitchen. Friends began to visit. They said, “We love your place.” As I walked around the vacuumed soft carpet and outside among the newly trimmed hedges, pruned eucalyptus, reseeded pastures and freshly dragged arena, I said to myself, “They are right. I love this place.”

But there was sadness here for me as well—the tack room with photos of children long grown and horses long passed lining the walls, the empty bedrooms, and the dogs dearly departing, one by one. And the cost of maintenance in drought stricken energy gridlocked southern California was a daily reminder of the fact that in March of this year, I retired from my full time job so that I could experience a little more life, and a little less death. It was a good decision, and one I don’t regret, but a reduction in cost of living was a necessary corollary. So the house went on the market, and here we are. I need to find a place to live and I don’t have much time. My youngest son, and eighty nine year old father are still here in San Diego, but I yearn for the open spaces and big skies of the west. New Mexico, with its spectacular sunsets and mix of cultures has indeed been the Land of Enchantment for me.

It’s not clear yet, but I may, like Huck, be soon lighting out for the territories. I hope you will all come and visit. Wish me good luck!

My 23 year old son says my blog posts are too long. He says that his generation believes that if you can’t say what you mean in 350 words or less, you’re not worth reading. At the writer’s conference I attended last spring, I learned that books sell best if there are odd numbers in the titles (never mind the commercial success of “Ten Things I Hate About You”). It has to be 5 or 7, because 6 and 8 just don’t cut it, and those of us old enough to remember know that Bo Derek is the only 10. So here is my attempt at listing important things to know about how medicine works these days, in no particular order.

No news is NOT good news anymore. The days of doctors calling you with your test results are, for the most part, over. Do not assume that because you did not get a call, everything is fine.

If we are treating you, please report your side effects so we can help you. You don’t get brownie points for being a “good patient” by keeping quiet—you just get sicker.

Please do not bring samples of bodily excretions in to the office on toilet paper in plastic bags. You might make someone sick. That someone might be the doctor. Brief quantitative and qualitative descriptions work well.

If you need to get your doctor’s attention, one phone call may not be enough even though it should be. Go ahead, be a pain in the ass. If the person up front gets tired enough of hearing from you, Facebook might be closed out and a message conveyed.

Insurance companies are not your friends. They will NOT call you back. If you call and get a phone tree, press “zero” until a human being comes on, and then demand to speak to a supervisor. Your life and bank account depend on it.

Know the names of your medications and their doses, and if you can’t remember, write them down and put them in your wallet. Please don’t say, “A little yellow pill.” UNDERSTAND what the pill does. Not knowing can kill you.

Don’t say “I have the flu” when you have a cold or a little upset stomach. Get your flu shot this fall or you will figure out what the real flu is when you really have it.

I could go on but I won’t. As they say in obedience training, “Exercise finished!”

I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights. The show stars Clive Owen as the charismatic cocaine addicted Chief of Surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop. The tagline is, as they say, priceless– “Modern medicine had to start somewhere.” On the third episode, last Friday night, Dr. Thackery performs a pedicle skin graft from the upper arm to cover a gaping hole in a woman’s face where her nose used to be, before she got syphilis. Back in those days, this was a marvelous feat. Real progress in what we now know as reconstructive surgery didn’t come until the end of World War I, when Sir Harold Gillies, a New Zealand otolaryngologist later known as the “father of plastic surgery,” established the first hospital ward for the facially wounded in Queen Mary’s Hospital in Kent.

For over fifty years, I have been a bystander to the evolution of plastic surgery. As a teenager I remember the heady early days of microvascular surgery—my father, Dr. Melvin Spira reattaching the scalp of a man whose hair got caught in machinery, then the tales of sewing back severed fingers and ultimately entire limbs with gradually improving functional results. In the 1970’s the great French surgeon Dr. Paul Tessier, pioneer in techniques for cranio-facial surgery to correct birth defects came to the United States to teach, and I remember a Saturday morning clinic at my father’s office, where mothers whose children’s facial deformities were so severe that these kids had, literally, never seen the light of day waited in line to be seen by the great surgeon who could give them back a normal appearance, and thus a life.

Plastic surgery, like my own specialty of Radiation Oncology, has become one of the “lifestyle” specialties to which medical students aspire, particularly those with an artistic bent and good hands, and for good reason. Cosmetic procedures are highly reimbursed, and are done during “regular” working hours. Walking around here in San Diego and Los Angeles, surely two of the plastic surgery capitals of the world, it’s easy to spot who has had “a little work” done. Having one face lift might be a good thing (I wouldn’t know because, as I’ve covered in previous blog pieces, my imagination runs wild with the possibilities of complications and I am far too chicken for elective surgery), but have three and you become one of “Our Ladies of Perpetual Surprise”, eyebrows at the hairline. Same goes for breasts—it is not normal for the “girls” to be rigidly immobile as their owner pounds away at the Stairmaster.

Last year I mentored a medical student who had started his medical education thinking that he wanted to become a plastic surgeon. After a beloved aunt developed breast cancer and needed radiation, he started to think that perhaps he would rather become a radiation oncologist because he enjoyed dealing with cancer patients. He was an outstanding student, and I was quite sure that he would be accepted, and do well in either specialty. I assured him that with his gifts, and his compassion, he could combine his interest in helping cancer patients with his interest in reconstructive and restorative surgery. Residency interviewers for plastic surgery residencies have a difficult job these days: all of the applicants SAY they want to do reconstructive surgery, but most end up doing cosmetic work. Apparently my student was convincing when he said he wanted to do plastic surgery to help cancer patients. He started his plastic surgery residency at Stanford last month. Dr. John Thackery of “The Knick” may be fictional, but I hope that my student leads the way in new innovations in reconstructive surgery. My cancer patients may depend on it.

“Upon what instrument are we two spanned, and what musician holds us in his hands?”

Rainer Maria Rilke

This past week was a very busy yet very interesting time for me. Early in the week, I had a visit from an old medical school classmate who is now one of our nation’s leading researchers in diabetes and other endocrine diseases. Although most of his time is spent in the lab, he still prides himself on being an outstanding clinician, and I can attest to that. I would choose him for my own personal physician any day, were he not based at Duke in Durham, NC. He told me the following story: a few months ago he was the attending physician on the endocrine consultation service. The fellow on duty was called for a consult on a middle aged man who needed an amputation for vascular complications related to his diabetes, and the surgeon needed to make sure his blood sugars were under control before taking him for surgery. The endocrinology fellow assessed the patient’s insulin requirements, and also mentioned that the man was complaining of some mild upper back pain, which seemed insignificant at the time. The case was presented to my friend, was assessed to be routine, and the patient went to surgery. Shortly after the operation, the man suffered a cardiac arrest due to a myocardial infarction in the posterior circulation. He did not survive. My friend, whose job was NOT to assess the patient’s cardiac status, but rather his diabetic control, is still beating himself up about the patient’s death, many months later. He insists that he should have asked the surgeon for a cardiac work up prior to the surgery.

On Thursday, I flew to Kalispell, MT to attend my nephew’s graduation from Montana Academy, a boarding school dedicated both to academic excellence, and the therapeutic mission of helping teenagers with problems learn to cope in positive ways. At the graduation ceremony, I was moved to tears several times, first by the headmaster’s recounting of the tale of Odysseus and the Cyclops as an analogy for the importance of finding and declaring one’s true identity, and later by the speeches of some of the parents whose children had benefited from this school, set in the green pastures and foothills of Montana. Finally, and even more importantly, some of the students themselves spoke, hesitating at first and stumbling over their words, but gaining strength from the support of the gathered crowd as well as their teachers, counselors and the founders of the school sitting behind them. The students spoke of the failures which led them to the academy, each small but increasingly significant success they met there, and their hopes and dreams for the future. These students were articulate and impressively intelligent. The last student who spoke was particularly moving, when she said, “Here I discovered that I am worthy of love, and that I DESERVE to love and be loved in return.”

We all strive for perfection, and yet for most of us it is our failures which teach us the meaning of life and of being human. Some of us are lucky enough to learn this at eighteen, but many of us are still learning these lessons at sixty. Last night, as I prepared for bed a row of necklaces I have hanging from pegs in the bathroom caught my eye—fossil mammoth ivory turned blue from arctic hoarfrost, and set with a fire opal, lapis prayer beads from Bhutan, ancient carnelian beads from the mountains of Nepal, and an old Chinese quartz crystal set in silver with enameled symbols of yin and yang. I wondered, for myself, for my nephew and for my old friend, what talismans are these which can keep us safe, which can protect us from our own demons? And what great musician holds us in his hands? We can only continue to do the very best we can.

Labor Day, 2006, is a day I will never forget. It was a gorgeous day here in San Diego—bright, sunny and nearly 90 degrees. I decided it was a perfect day to give the dogs an outdoor bath. At the time, we had Valentine, the matriarch at nearly twelve years old, Izzy who was four, and the two young ones Magic and Angelina who were two years old. We started with Valentine—at her age she’d had a little problem with urinary incontinence, and she needed her bath the most. We knew that the coiled up hose sitting in the sun on that hot afternoon had enough warm water to bathe her in, so my daughter and I mixed shampoo in a bucket of hot water from the kitchen sink, and just outside the garage, we soaped her up. She seemed to be enjoying herself, a nice soapy massage on a beautiful day, and then a quick rinse. As I turned to get the towel to dry her, I heard my daughter say loudly and in a panic, “VAL, DON’T FALL DOWN!” I turned back around and she was gone, down on the wet pavement, eyes blank. She never felt a thing. I spent the rest of the afternoon sitting on the driveway with my dead dog, brushing her hair until it dried and the crematorium people came to take her away. Needless to say, no one else got a bath that day.

I once read an essay by an oncologist who said that she hoped that she would die of cancer. I was baffled by this, because my personal preference would be to go suddenly, of a heart attack or a massive stroke, preferably while doing something I enjoy. But her reasoning was quite clear: she said that with cancer, when you know that your days on earth are numbered, you still have time—time to do the things you always wanted to do, time to say good bye, time to make amends. This has actually been true for most of my patients—when they know that they are diagnosed with a life threatening illness, their priorities change. If they have the means, they live the lives they always wanted to live, for as long as they are able. They remember, they forgive and they forget. The trivialities of daily life become unimportant, except insofar as they struggle to get through them. Many become the person they always wanted to be, and I hope that if this is my fate, I have the grace to do the same.

Today we took old Magic to the veterinary cardiologist. Magic is my eldest deerhound—a big male at 120 pounds, and nearly ten years old. The last two weeks have been hard for him—we’ve had thunderstorms and he has always been afraid of thunder. In desperation over his anxiety last week I called his vet for a prescription for a tranquilizer. It worked temporarily, but on Tuesday we had strangers in the house and he was panting, salivating, and his heart was beating far too rapidly. I laid a hand on his chest and I knew instantly that his big old heart was failing. Today the diagnostic echocardiogram confirmed what I already knew—that my big guy has dilated cardiomyopathy, and that he is in congestive heart failure. We started medication immediately, and I am hoping for a few more weeks, or a few more months with this grand old man who is, as my husband says, “the dog who never did anything wrong.”

Do dogs, like humans, know when they are dying? I don’t think so. And in fact, for their sake, I hope not. Unlike us, they have nothing to apologize for, and perhaps their next meal, or a walk in the park, or in a dream a wild chase after a highland stag, followed by a soft bed and the touch of a human hand is all that they hope for and dream about. As Magic slowly made his way out of the van today onto solid ground, he was greeted warmly by Queen, Quicksilver and little Yoda. I can no longer promise him a life beyond his years, but I promised him today that every day from now on will be the best day I can give him—lots of treats, a comfortable place to rest, and with all certainty, no more baths.

These days I have begun to separate my life into two separate eras which I call BE and AE, “before eBay” and “after eBay.” How could there have been so many things in the world which I never knew that I wanted? I think back to the early days of my marriage, when my husband and I lived in a 1400 sq ft Victorian “doll house” with wide board pine floors and a pitched roof and wonder how I managed to live without so many “accessories?” It wasn’t until we moved to California, and bought a Spanish style home with very large rooms (“Honey, I shrunk the furniture!”) that the woman who owned the store where I bought my new furniture declared, “Now all you need to do is accessorize!” And so I did. Ebay became the source of my many so called “accessories,” previously known to the world of interior design by the Yiddish word “tchotchkes.” Who knew that thistle themed items could be so attractive, and yet so ubiquitous?

The upside of eBay is that after a while you get to know who the best sellers are. Everyone makes mistakes at first—I remember the alligator skin antique doctor’s bag which looked SO good in the pictures, but smelled SO bad when it arrived that it went straight into the outdoor dumpster by the barn, usually reserved for horse manure. Sometimes antiques are charming and full of character. But sometimes they are just plain old and smelly. When I got my first deerhound many years ago, I became interested in all things Scottish, and discovered that Queen Victoria of England, was similarly enchanted with Scotland, where the royal family still maintains Balmoral Castle. In the mid to late 19th century, Scottish “pebble” jewelry became immensely popular, formed from polished agate typically surrounding a faceted cairngorm, a type of quartz mined in the Cairngorm mountains. Brooches of this design, especially the larger ones, were commonly used on kilts, particularly to fasten the shawl or upper portion of the kilt known as the “plaid.” In addition to beautiful rocks, Victoria also loved dogs and children, in that order– the phrase “children should be seen and not heard” is attributed to her reign. Portraits and etchings of the dog breeds she loved, including the deerhound, abound from that era. And judging from the walls of my home, I seem to have located most of them!

For the past several years, I have put on an auction to help raise money for our West coast Scottish deerhound club. The money raised helps us put on our annual regional show and allows us to subsidize our traditional after show dinner. This year I did it for the National show as well. I have discovered that my enthusiasm for Scottish and Victorian artifacts is transferable. I mean, who DOESN’T want to picture themselves as a wild red haired Scottish lassie dancing around the May pole in the rain, or a strong handsome barrel chested kilted lad leaning against the standing stones of remote mountains? And if you haven’t ever thought of it, tune in to the upcoming new Starz series “Outlander” and you too will be longing for a kilted man, pebble brooches, thistle emblazoned artifacts and an antique etching or two. I have begun to give away some of my collection so that others can share the romance of the Highlands. Join us and share the fantasy—the best is yet to come. And by the way, a deerhound puppy is a prerequisite, ye lairds and ladies!

I’ve always been good at pattern recognition and my visual/spatial orientation is excellent. Photography is my hobby, so it was only natural that as a medical student and internal medicine resident, I loved my dermatology electives. Each day yielded up a new parade of interesting skin lesions and rashes, and by the end of my rotations I was confident in my diagnoses and recommendations—contact dermatitis?—steroids! Eczema?—steroids! Psoriasis—yep, you got it—steroids again! Pimples? Well that was a diagnosis that required antibiotics. But sometimes, when it was really bad—yes, STEROIDS! These were the days before Botox, and Restylane, and non-invasive mini-lifts, and lasers. Occasionally there was the excitement of a skin cancer, or a truly serious life threatening dermatologic crisis, but as much as I enjoyed saying the words “pemphigus”, or even “bullous pemphigoid” (try it—they roll right off the tongue)—I didn’t want to spend my career looking at it. I chose radiation oncology after my internal medicine residency, and never looked back. I wanted to take care of sick people.

When I announced my retirement in February, the calls started coming in immediately. Having moved several times since I graduated from medical school, I hold medical licenses in three states which makes me a prime candidate for companies who supply locum tenens or “hired hands”– doctors who cover practices while the regular doctor goes on vacation, takes maternity leave, or just needs a break. I was vaguely interested, but not enough to commit to spending weeks away from home living in a hotel. But then a call came in from my old group, a Los Angeles based practice that had just set up a skin cancer treatment unit in a San Diego dermatologist’s office. The hours were reasonable, and the job was only two days a week, covering while the regular radiation oncologists took their summer vacations. This type of radiation machine, called the Xoft, is fairly new and uses a miniaturized high dose rate X-ray source to apply radiation directly to the skin cancer, while minimizing the dose to surrounding tissues. For basal cell and squamous cell skin cancers, the results are extremely good, with excellent cosmetic results providing a great alternative to the Moh’s procedure which can leave patients with a significant “divot” in their faces, sometimes requiring skin grafts. Dermatologists can buy these machines, however they are not legally allowed to operate them, having no training or background in radiation therapy. That’s where I come in.

For the last two weeks, I’ve spent Mondays and Wednesdays in the dermatologist’s office. It is a remarkably busy office with seven exam rooms going at all times, an operating suite and numerous medical assistants scurrying around with headsets on to communicate with Central Command. The atmosphere is similar to what I would imagine the air traffic control room is like at JFK. No one ever goes to the bathroom or takes a lunch break. There are flat screen TV sets in every exam room, to entertain the patients while they wait (try explaining skin cancer treatment with radiation to an 86 year old with bilateral hearing aids watching an episode of “24”—challenging to say the least!) As the physician in charge of radiation, I must set up each patient to make sure the applicator is placed correctly. This involves a brisk walk down a long hallway from my makeshift office to the radiation room many times a day.

In the middle of that hallway, mounted on the ceiling, there is a television which runs a continuous infomercial about the joys of cosmetic dermatology. It took me a few passes to notice it, but once I did, I was mesmerized. The pulsatile blue light of the laser erasing wrinkles, the miniscule needles injecting the varicose veins, the tightening of the dewlap under the chin and the apparent dissolution of fatty deposits in the wrong places and their magical reappearance to plump the cheeks and add youth to the lips were hypnotic. A head-setted medical assistant colliding with my ample in-need-of-liposuction derriere brought me back to reality and the skin cancer patient waiting.

I am beginning to see some advantages in my current part time job. I smile brightly at the dermatologist in his scrubs. He is an MD-PhD and very smart to have hired radiation oncologists to treat his skin cancer patients. I have a new admiration for the tools of his trade. I think that if I am really diligent, I might just get a free consultation and who knows—with a little buffing and polishing and injecting—a whole new face!

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About

In 2012, I realized that my thirty plus years of practice as a radiation oncologist had provided me with an abundance of stories–happy, sad, compelling and inspiring–and that these stories needed to be told. Along the way, stories from my “other life” as a mother of three, a daughter, an animal lover, and an occasional world traveler crept in. I hope you enjoy my stories as much as I enjoy telling them.